Transcript AS – the facts!

Andrew Keat
Spectrum of Axial Spondyloarthritis
Patients with chronic back pain ≥3 months and aged <45 years
Axial SpA (ASAS criteria)
Non-radiographic stage
Estimated proportion of affected individuals*
X-ray-negative
MRI positive
sacroiliitis
Ankylosing Spondylitis (modified New York criteria)
Radiographic stage
X-ray-positive sacroiliitis
Radiographic stage
X-ray-positive sacroiliitis and/or
spinal changes***
Time
* Heights reflect an estimate of the proportion of patients in each group
** Clinical arm if non-radiographic axial SpA
*** Radiographic evidence if inflammatory spinal changes including i.e., syndesmophytes, fusion or posterior element involvement
The Spine…..
…and Sacroiliac joints
Spondylitis
Enthesitis
Back to Action
Does exercise really do any good?
The Book
Exercising safely in a gym with AS
Copy distributed free to all UK rheumatology departments during 2012
Available to purchase from NASS online shop (www.nass.co.uk)
Available to download free of charge as a PDF from exercise pages on NASS
website
Exercise leads to
 Improved strength and fitness (=feel better)
 Reduced IL-6
 Reduced CRP
 Increased IL-10
Exercise leads to
 Improved strength and fitness (=feel better)
 Reduced IL-6
 Reduced CRP
 Increased IL-10
=Less inflammation
……….if it is regular!
DANBIO: Survival curves of TNF
inhibitor use in AS
Sex
(A)
Baseline BASDAI
(B)
1.0
1.0
0.8
0.8
0.6
0.6
0.4
0.4
0.2
0.2
1. quartile (low)
2. quartile
Men
3. quartile
Women
0.0
0
1
2
4. quartile (high)
0.0
3
4
5
Glintborg B et al. Ann Rheum Dis 2010;69:2002–2008.
6
7
0
1
2
3
4
5
6
7
DANBIO registry: drug adherences
by treatment course
Proportion of patients
maintaining treatment
1.0
Treatment course
1
2
3
0.8
0.6
Course
N
Maintaining
treatment
after 2 years,
%
Drug survival,
years
Median (95%
CI)
1
1436
58
3.1 (2.6-3.7)
2
432
47
1.6 (1.0-2.2)
3
137
49
1.8 (0.9-2.7)
0.4
0.2
0.0
0
2
4
6
8
10
Treatment duration, years
Drug survival decreased after switching ( p<0.0001)
Glintborg B et al. Ann Rheum Dis. 2013;72(7):1149-55.
What next?
Anti-TNFs:
Certolizumab
Other Biologics:
Secukinumab
Small molecules:
Apremilast
Biosimilars
Terms
Definitions
Implications
Biosimilar
Copy version of already
authorized medicinal
product: Demonstrated
similarity in chemical
structure, efficacy and safety
Only very small differences
from original. Extrapolation
of indications justifiable
Terms
Definitions
Implications
Me-too biologic
Biological medicinal product
developed on its own and
not directly compared with a
licensed biological
Not known whether
chemical, clinical differences
exist between it and other
biologicals in the same class.
Therefore extrapolation of
indications is problematic
Terms
Definitions
Implications
Biobetter/second generation
biologic
Structurally or functionally
altered biologic to achieve
improved or different
performance
Usually considered as a new
agent. Claim to be “better”
would have to be stringently
demonstrated
Terms
Definitions
Implications
Biosimilar
Copy version of already
authorized medicinal
product: Demonstrated
similarity in chemical
structure, efficacy and safety
Only very small differences
from original. Extrapolation
of indications justifiable
Me-too biologic
Biological medicinal product
developed on its own and
not directly compared with a
licensed biological
Not known whether
chemical, clinical differences
exist between it and other
biologicals in the same class.
Therefore extrapolation of
indications is problematic
Biobetter/second generation
biologic
Structurally or functionally
altered biologic to achieve
improved or different
performance
Usually considered as a new
agent. Claim to be “better”
would have to be stringently
demonstrated
Don’t forget surgery!
Images courtesy of Dr Keat.